Flow cytometry in acute myeloid leukemia and detection of minimal residual disease.

Acute myeloid leukemia (AML) is a common type of acute leukemia (AL), belonging to malignant tumors of the hematopoietic system with the characteristics of rapid disease development, control with extreme difficulties, easy recurrence, poor prognosis, and incidence rate increasing with age. The traditionally diagnostic standard of French American British (FAB), being based on the morphological examination with high human subjectivity, can no longer meet the demand of clinical diagnosis and treatment of AML. Requirements of objective accuracy and low-dose sample, have become the indispensable method for AML diagnosis and monitoring prognosis. Flow cytometry is a modern technology that can quickly and accurately detect the series, antigen distribution, differentiation stage of AML cells, minimal residual lesions after AML therapy, so as to provide the great significance in guiding clinical diagnosis, hierarchical treatment, and prognosis judgement. This article will systematically elaborate on the application of flow cytometry in the diagnosis and classification of AML, and the detection of minimal residual lesions, thereby providing reference significance for dynamic monitoring and prognostic observation of AML with different immune subtypes of FAB.

Comparing Lesion Conspicuity and ADC Reliability in High-resolution Diffusion-weighted Imaging of the Breast.

PURPOSE: This study investigated the breast lesion conspicuity and apparent diffusion coefficient (ADC) reliability for three different diffusion-weighted imaging (DWI) protocols: spatiotemporal encoding (SPEN), single-shot echo-planar imaging (SS-EPI), and readout segmentation of long variable echo-trains (RESOLVE). METHODS: Sixty-five women suspected of having breast tumors were included in this study, with 44 lesions (36 malignant, 8 benign) analyzed further. Breast MRI was performed on a 3 Tesla (3T) system (MAGNETOM Prisma, Siemens) equipped with a dedicated 18-channel breast array coil for a phantom and patients. Three DWI protocols-SPEN, SS-EPI, and RESOLVE-were used. SS-EPI was acquired with an in-plane resolution of 2 × 2 mm2, a slice thickness of 3 mm, and b-values of 0 and 1000 s/mm2. SPEN had a higher in-plane resolution of 1 × 1 mm2, a slice thickness of 1.5 mm, and b-values of 0, 850, and 1500 s/mm2. RESOLVE was acquired with an in-plane resolution of 1 × 1 mm2, a slice thickness of 1.5 mm, and b-values of 0 and 850 s/mm2. Lesion conspicuity and ADC values were evaluated. RESULTS: The average lesion conspicuity scores were significantly higher for RESOLVE (3.54 ± 0.65) than for SPEN (3.07 ± 0.91) or SS-EPI (2.48 ± 0.78) (P < 0.01). The SPEN score was significantly higher than the SS-EPI score (P < 0.01). Phantom measurements indicated marginally lower ADC values for SPEN compared to SS-EPI and RESOLVE across all concentrations. The results revealed that SPEN (b = 0, 850, 1500 sec/mm2) yielded significantly lower ADC values compared to SPEN (b = 0, 850 sec/mm2) in malignant lesions (P < 0.01), with no significant difference observed between SPEN (b = 0, 850 sec/mm2), SS-EPI, and RESOLVE. For benign lesions, no significant difference in ADC values was found between SPEN (b = 0, 850 sec/mm2), SPEN (b = 0, 850, 1500 sec/mm2), SS-EPI, and RESOLVE. CONCLUSION: RESOLVE provided the highest lesion conspicuity, and ADC values in breast lesions were not significantly different among sequences ranging b values 850-1000 sec/mm2. SPEN with higher b-values (0, 850, 1500 vs. 0, 850 sec/mm2) yielded significantly lower ADC values in malignant lesions, highlighting the importance of b-value selection in ADC quantification.

Evaluation of outcomes of clinical phenotyping-based treatment for bladder pain syndrome/interstitial cystitis.

Introduction: Bladder pain syndrome/Interstitial cystitis (BPS/IC) is clinically of diverse types because different causes contribute to the development of their symptoms. It is important to classify patients into various groups based on the possible etiopathogenesis of their condition. Treatment may be tailored to each specific group according to the possible cause. Methodology: Twenty-five patients diagnosed with BPS/IC were categorized into four different clinical phenotypes (CP) based on their history of symptoms, allergy, dysfunctional voiding, neuropathic pain, and the presence of Hunner's ulcer. Some patients could be classified into multiple groups. The patients were given oral pentosan polysulfate, and treatment specific to their CP. Patients in CP1, CP2, and CP3 groups received, respectively hydroxyzine, clonazepam, and amitriptyline. Patients with Hunner's lesions (HL) (CP4) underwent hydro distension and ablation of the lesion, followed by intravesical instillation of heparin and hydrocortisone. The patients were evaluated using the Apollo clinical scoring (ACS) system and their clinical scores were recorded at 1, 3, and 6 month(s). Results: Among the 25 patients, 5, 7, 4, and 9 patients were classified into CP 1 - CP4 groups respectively, and were all subjected to ACS assessment. In CP1 group (allergy group), 80% (4/5) of patients responded well to the treatment and 20% (1/5) had unsatisfactory responses. In CP2 group (dysfunctional voiding group), 71.42% (5/7) patients had good, and 28.57% (2/7) had excellent responses. In CP3 group (neuropathic pain group), 28.57% (3/4) patients had excellent, and 75% (1/4) patients had good responses. In CP4 group (HL group), 33.33% (3/9) patients had unsatisfactory, 44.44% (4/9) achieved good, and 22.22% (2/9) had excellent responses. Overall, 16% (4/25) patients had unsatisfactory, 56% (14/25) attained good, and 28% (7/25) had an excellent response at the completion of the study. Conclusion: Using clinical phenotyping-based features indicative of etiology could potentially improve treatment outcomes by targeting the specific pathological processes contributing to the patients' symptoms.

Association of bacteriomes with drug susceptibility in lesions of pulmonary tuberculosis patients.

Understanding how the bacteriomes in tuberculous lesions can be influenced by the susceptibility of Mycobacterium tuberculosis (MTB) can provide valuable information for preventing and treating drug resistant tuberculosis (DR-TB). High-throughput 16S rRNA sequencing was employed to analyze the bacteriome in pulmonary TB lesions from 14 patients with DR-TB and 47 patients with drug sensitive tuberculosis (DS-TB), along with 18 normal lung tissues (NT) from 18 lung cancer patients serving as the bacterial baseline. The phylogenetic investigation of communities by reconstruction of unobserved states2 (PICRUSt2) algorithm was utilized to predict bacterial metabolic functions. The major phyla of pulmonary bacteriomes included Proteobacteria, Actinobacteria, Bacteroidetes, Firmicutes and Fusobacteria. Alpha diversity indices, including ACE, Chao1, Shannon and OTU observed, all demonstrated different bacterial communities of DS-TB samples from that of NT samples; while only Shannon indicated difference between DR-TB and NT samples. The analysis of similarity (ANOSIM) showed significantly different bacterial communities within TB lesions compared to NT samples (R = 0.418, p = 0.001). However, difference was not observed between DR-TB and DS-TB samples (ANOSIM, R = 0.069, p = 0.173). The bacterial profiles within each DR-TB individual appeared unique, with no obvious clusters corresponding to drug-resistant phenotypes. Nevertheless, indicator genera identified in DR-TB and DS-TB lesions demonstrated distinctive micro-ecological environments. Most COG functions were enriched in TB lesions, and the most significant one was [J] translation, ribosomal structure and biogenesis. The distinct enrichment patterns of bacterial enzymes in DR-TB and DS-TB lesions suggest that pulmonary bacterial activities can be modulated by the susceptibility of MTB bacilli. This study provides fresh perspectives and strategies for the precise diagnosis and assessment of drug resistance tuberculosis.

Clinical utility of multi-row spiral CT in diagnosing hepatic nodular lesions, gastric cancer, and Crohn's disease: a comprehensive meta-analysis.

A retrieval of relevant literature on hepatic nodular lesions, gastric cancer (GC), and Crohn's disease (CD) was conducted from Chinese and English databases. Meta-analysis was performed using Review Manager 5.4 software and the MIDAS package in Stata 18.0. Results from 11 studies comprising 1847 patients were synthesized. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio with 95% confidence intervals were: 0.91 (0.84-0.95), 0.73 (0.65-0.79), 3.30 (2.60-4.30), 0.13 (0.07-0.23), and 26.00 (12.00-53.00), respectively. Significant statistical heterogeneity was found in sensitivity and specificity (P<0.05), with specificity heterogeneity originating from n, type, and mode (P<0.05). Sensitivity and specificity for n, type, object, and mode were non-heterogeneous (P>0.05). The combined AUC from SROC curve analysis of the 11 studies was 0.85. Deeks' funnel plot asymmetry test yielded a p-value of 0.01, indicating potential bias across studies in the diagnostic odds ratio funnel plot. Fagan's nomogram demonstrated that using CT for diagnostic modeling increased the post-test probability of correctly diagnosing hepatic nodular lesions, GC, and CD from 50.00% to 77.00%. Overall, multi-detector CT shows good diagnostic value for hepatic nodular lesions, GC, and CD, supporting its clinical flexibility based on patient-specific considerations.

Revisiting the etiology and clinical characteristics of hemorrhagic polyps of the vocal fold.

Objective: Benign phonotraumatic lesions of the vocal folds (BVFLs) are typically seen in younger female patients with high vocal loads. Hemorrhagic polyps (HPs) do not fit the classic paradigm of most BVFLs, as they tend to occur in an older population, have a male predominance, and report to result from a vocal accident. We present one of the largest cohorts of HPs, to reexamine their etiology and clinical features. Methods: Retrospective cohort study, inclusive of all patients with HP managed by the senior authors between the years 2016 through 2023. Demographic data, management, phonotraumatic risk factors, pre- and post-treatment VHI-10 were reviewed. We examined patient videostroboscopy, categorized the size of the lesion, and identified any concurrent mucosal abnormality. Results: One hundred and eleven patients had confirmed HP, 84 males (75.7%). Thirty-five patients were size category 1; pinpoint (28.9%), 57 were category 2; less than 1/3rd the vocal fold (45.5%), and 26 were category 3; greater than 1/3rd the vocal fold (21.5%). Ten patients (9%) had bilateral HPs. Thirty-five patients had an additional 40 mucosal lesions in addition to the HP(s). The onset of symptoms was gradual in 60% of patients. The mean pretreatment VHI-10 was 18.0 (SD 10.7), compared to 6.0 (SD 10.5) post-treatment, (p < .001). 57/111 patients reported high voice demand professions or recreational activities. The average self-reported talkative scale score was 7.6/10. Patients were managed with operative microdirect laryngoscopy and microflap excision (53.1%), in-office clinic potassium titanyl phosphate (KTP) laser (24.3%), voice therapy alone (7.2%), and KTP in the operating room (6.3%). Conclusions: In our cohort, most patients were male, had high vocal demands, reported gradual symptom onset, and almost a third of patients had additional BVFLs. Level of evidence: Level 3: Retrospective cohort study.

Magnetic Resonance Imaging (MRI) Evaluation and Classification of Vascular Malformations.

Introduction Vascular malformations of the soft tissues are a diverse collection of lesions frequently encountered in clinical practice. Vascular malformations are rare and complex abnormalities that affect both children and young adults. Low-flow malformations are more common in children and often become symptomatic in later years. These malformations are common causes of soft tissue masses in children and can affect any part of the body at any age. Significant advancements in the management of these conditions have been made due to the implementation of a comprehensive binary categorization system, which classifies vascular abnormalities into tumors and malformations based on their clinicopathological characteristics. Imaging, particularly magnetic resonance imaging (MRI), plays a crucial role in the accurate identification, localization, and classification of these lesions, aiding in the development of appropriate treatment plans. Materials and methods This prospective study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, from August 2022 to June 2024. Fifty patients of all age groups with clinically suspected soft tissue vascular malformations were included. MRI was performed using a MAGNETOM Vida (3T) Scanner (Siemens Healthcare Private Limited, Mumbai, India), and ultrasound was used as an adjunct. Institutional Ethics Committee clearance and informed consent were obtained. The study employed various MRI sequences, including T1-weighted imaging (T1WI) fast spin echo (FSE), T2-weighted imaging (T2WI) FSE, short tau inversion recovery (STIR), T2-weighted gradient recalled echo (GRE), pre-contrast fat-saturated T1WI, 3D post-contrast T1WI, diffusion-weighted imaging (DWI), and ANGIO TWIST (time-resolved angiography with interleaved stochastic trajectories) ISO. Results The study included 50 patients, with a male predominance of 28 (56%). The mean age was 22.13 years, and the average duration of vascular malformations was 32.94 months. The swelling was present in 43 (86%) of patients, and 35 (70%) had superficial lesions. MRI findings revealed hypointensity on T1 imaging in 40 (80%) patients and hyperintensity on T2 imaging in 49 (98%) cases. STIR sequences showed hyperintensity in all patients. The most common type of vascular malformation was slow-flow 46 (92%), with venous malformations being the most prevalent 39 (78%). Conclusion MRI is a valuable imaging modality for the evaluation and classification of vascular malformations, providing detailed information on lesion extent and involvement of surrounding tissues. The findings support the use of MRI as a primary tool in the assessment of vascular malformations, with ultrasound serving as a useful adjunct in certain cases. Further studies with larger sample sizes are recommended to validate these findings and refine imaging protocols.

Additional Scapular Spine Bone Grafting Combined with Bankart and Remplissage for Off-Track Hill-Sachs Lesions with Subcritical Glenoid Bone Loss: Provides Better Stability.

PURPOSE: Arthroscopic Bankart repair combined with remplissage and autologous scapular spine bone grafting have been described as a treatment for off-track Hill-Sachs lesions with subcritical glenoid bone defects in the anterior shoulder instability. However, whether these two techniques can achieve satisfactory postoperative outcomes is unclear, and there are few comparative studies between them. Therefore, this study compared the postoperative efficacy of the two techniques for off-track Hill-Sachs lesions with subcritical glenoid bone loss. METHOD: Between June 2017 and December 2020, 62 patients with shoulder instability due to Off-Track Hill-Sachs lesions with subcritical glenoid bone loss underwent surgical treatment and were included in this regression study. Thirty-two patients underwent arthroscopic Bankart repair combined with remplissage (B + R group), and 30 patients underwent additional autologous scapular glenoid bone grafting (additional bone grafting group). The general information of the patients was recorded. The patient's activity before and after surgery was recorded. The DASH score and Constant-Murley (CM) score were used to assess the patient's functional status; the Rowe score was used to evaluate the patient's shoulder stability. The shoulder function and stability before and after surgery were analyzed and compared between the two groups. RESULTS: The final DASH scores of the B + R group and the additional bone grafting group were significantly lower than those before surgery, with a statistically significant difference (9.76 ± 4.32 vs. 27.89 ± 6.63, 8.50 ± 3.32 vs. 28.0 ± 4.27, p = 0.000); the final CM scores of the two groups were significantly higher than those before surgery (88.71 ± 3.74 vs. 73.68 ± 3.74, 87.16 ± 2.29 vs. 71.37 ± 2.68, p = 0.000). There was no statistical difference in the final DASH score and final CM score between the two groups (p > 0.05). In terms of postoperative stability, the final Rowe scores of the two groups were significantly higher than those before surgery, with a statistically significant difference (89.06 ± 9.19 vs. 41.71 ± 4.13; 93.16 ± 4.99 vs. 42.33 ± 2.53, p = 0.000). Compared with the control group, the additional bone graft group achieved higher final Rowe scores (93.16 ± 4.99 vs. 89.06 ± 9.19, p = 0.032). CONCLUSION: For patients with anterior shoulder instability due to off-track Hill-Sachs lesions with subcritical glenoid bone loss, although Bankart and remplissage can achieve satisfactory clinical results, additional autogenous scapular spine bone grafting can provide better stability of the shoulder, especially for patients with high sports demands.

A complete course of photodynamic therapy reduced the risk of malignant transformation of oral leukoplakia.

BACKGROUND: Photodynamic therapy (PDT) has shown good short-term efficacy in the treatment of oral leukoplakia (OLK). However, the malignant transformation of OLK was seldom evaluated in most PDT studies. Therefore, this study evaluated the effect of PDT on the risk of malignant transformation of OLK. METHODS: Kaplan-Meier survival analysis, COX regression, and sensitivity analysis were used to evaluate the effects of PDT on the risk of malignant transformation of OLK. Subgroup analyses were performed to explore the role of PDT in OLK patients with different clinical characteristics. RESULTS: OLK patients with older age (HR=1.032, P=0.018) and non-homogeneous lesion (HR=2.104, P=0.044) had higher risk of malignant transformation. Patients who had finished a complete course of PDT (HR=0.305, P=0.006) had a significant lower risk of malignant transformation, while those who hadn't finished a complete course of PDT (HR=0.692, P=0.352) cannot be considered to have such a protective effect. In the subgroup analyses, complete PDT course showed a significant protective effect on malignant transformation of OLK in patients with female sex, no smoking or drinking habits, non-homogeneous lesions, lesions on oral mucosa outside the dangerous region, and any grade of epithelial dysplasia. CONCLUSIONS: A complete course of PDT could significantly reduce the risk of malignant transformation of OLK, especially in those patients with risk factors of malignant transformation.

Exploration of Fractional Flow Reservation Score Based on Artificial Intelligence Post-processing for Coronary Artery Lesions in Patients with Diabetes and Coronary Heart Disease.

In order to evaluate the relationship between coronary heart disease (CHD) and fractional flow reservation (FFR) in patients with different levels of CHD and diabetes, this paper used AI (artificial intelligence) post-processing technology to detect CHD and FFR. In this paper, 94 patients suspected of CHD who underwent coronary arteriography (CAG) in a hospital between December 2022 and February 2023 were examined by coronary computed tomography angiography (CCTA) and FFR. Based on CCTA, AI software is used to process CCTA images, diagnose coronary plaques, coronary stenosis, corresponding stenosis of different types of plaques, and FFR values. The diagnostic performance of AI was evaluated using expert diagnosis, CAG diagnosis, and FFR examination results as the "gold standard". According to the diagnosis results, the relationship between FFR and CHD patients with diabetes at different levels was studied. The research results showed that AI image diagnosis has high sensitivity, specificity, and accuracy, and has good diagnostic effects on coronary plaques, coronary stenosis, stenosis corresponding to different types of plaques, and FFR values. The fasting blood glucose levels and FFR values of three groups of CHD patients were statistically significant, and correlation analysis revealed a negative correlation between the two. Using AI for CCTA diagnosis can efficiently, conveniently, and accurately obtain the required data, improving clinical diagnostic efficiency and accuracy. The analysis of AI recognition results found that in patients with CHD, the FFR value of patients with diabetes decreased, and the FFR value was negatively correlated with the fasting blood glucose concentration, indicating that CHD patients may lead to myocardial ischemia in the blood supply area due to the decline of their coronary blood flow reserve. CHD patients with diabetes are very common. It is known that high blood sugar can cause coronary artery damage. Many CHD patients with diabetes have complex angiopathy, so the advantages and disadvantages of stent placement should be carefully considered in clinical practice. CAG is currently the most commonly used examination method in clinical practice, and is considered the "gold standard" for imaging evaluation and diagnosis of CHD. FFR evaluates the blood flow status in the coronary artery by measuring the pressure inside the coronary artery, and determines whether it has changed based on its changes (i.e. functional assessment). Diabetes is closely related to CHD and is a risk factor of CHD. The range of vascular lesions in diabetes patients is very wide, which can involve capillaries to large arteries, thereby damaging their microvascular function [1]. McKenzie-Sampson Safyer studied whether gestational diabetes would increase the risk of cardiovascular disease after more than 20 years [2]. Piche Marie-Eve discussed the interaction between obesity type 2 diabetes and cardiovascular disease [3]. Li Jing studied the relationship between pregnancy diabetes and long-term risk of cardiovascular disease [4]. Petrie John R discussed the pathophysiological characteristics of common diseases of diabetes and hypertension and related vascular complications [5]. Kemps Hareld proposed a physical exercise program suitable for type 2 diabetes with cardiovascular disease by analyzing the clinical characteristics of type 2 diabetes with cardiovascular disease [6]. Sattar Naveed analyzed the mortality and cardiovascular disease results of patients with or without type 2 diabetes [7]. Using FFR to study diabetes with CHD can help coronary artery remodeling and provide new ideas and methods for clinical treatment. Coronary artery CCTA is the preferred examination method for screening and diagnosis of CHD. However, the large number of coronary artery CCTA images requires doctors to perform post-processing, which brings a lot of workload to doctors. Doctors are prone to visual fatigue, and it can also lead to doctors missing out on coronary artery stenosis (CAS) segments and misevaluating the degree of stenosis [8]. AI technology have advantages such as speed, efficiency, repeatability, quantification, and low cost. The use of AI technology can appropriately reduce the workload of doctors in medical imaging diagnosis, which helps drive doctors to improve workflow and reduce the probability of errors [9]. von Knebel Doeberitz Philipp L studied the diagnostic efficacy of combining plaque markers generated by CCTA with deep learning (DL) based blood reserve scores [10]. Zhou Zhen further reduced the contrast agent dose for whole aortic CT angiography imaging using the enhanced period consistent adversarial framework algorithm [11]. AI can be used to measure CAS, plaque and FFR on CCTA images. This paper used AI to process CCTA images to assist in the study of diabetes with CHD. This article selected 94 patients with suspected CHD and uses AI for CCTA image analysis. The expert diagnosis results were used as the "gold standard" to evaluate the effectiveness of AI in identifying coronary plaques; using the CAG results as the "gold standard", the effectiveness of AI in identifying CAS was evaluated; using expert diagnosis and CAG results as the "gold standard", the effectiveness of AI in identifying stenosis corresponding to different types of plaques was evaluated; the effectiveness of AI in identifying myocardial ischemia was evaluated using FFR measurement results as the "gold standard". Based on the above diagnostic results, the relationship between FFR and the difference of CHD in diabetes patients with CHD was studied, and the correlation between FFR and the difference of CHD was discussed.

Procedural and clinical impact of intracoronary lithotripsy in heavily calcified aorto-ostial coronary lesions.

BACKGROUND: Percutaneous coronary intervention of calcified aorto-ostial lesions (AOL) pose unique challenges due to anatomical propensity for recoil, leading to poorer outcomes compared to non-AOL. Although intravascular lithotripsy (IVL) has shown excellent success and safety in heavily calcified plaques, evidence specific to AOL is limited. This study aims to evaluate the efficacy and safety of IVL in AOL versus non-AOL. METHODS: Patients treated with IVL between 2019 and 2023 from an ongoing prospective multicenter registry were eligible for inclusion. Patients were therefore classified in AOL and non-AOL groups, based on anatomical location. The primary technical endpoint was device success, defined as the ability to deliver the IVL catheter and pulses at the target lesion, without angiographic complications. Secondary technical endpoint encompassed procedural success <30%, consisting of device success with residual stenosis <30%, final thrombolysis in myocardial infarction grade 3 flow, and no in-hospital major adverse cardiovascular events (MACE). The primary clinical endpoint was in-hospital MACE, including cardiac death, nonfatal myocardial infarction, or target lesion revascularization. RESULTS: A total of 321 patients underwent IVL, including 48 with AOL. Device success showed no significant difference between AOL and non-AOL groups (100% vs. 98.2%; p = 0.35). A nonsignificant trend toward worse procedural success with residual stenosis <30% was observed in the AOL arm (AOL 81.3% vs. non-AOL 90.5%, p = 0.06). In-hospital MACE was significantly higher in AOL (4.2% vs. 0.7%, p = 0.048), attributed entirely to cardiac deaths. At 6-month follow-up, the incidence of MACE (AOL 8.3% vs. non-AOL 4.0%, p = 0.19), and cardiac deaths (AOL 4.2% vs non-AOL1.1%, p = 0.11) were comparable between groups. CONCLUSION: IVL treatment for heavily calcified AOL demonstrates comparable procedural and 6-month clinical outcomes when compared to non-AOL, despite a higher incidence of in-hospital MACE.

Evaluating the Remineralizing Effects of Calcium Sucrose Phosphate and Casein Phosphopeptide-Amorphous Calcium Phosphate Toothpastes on Artificial Carious Lesions Using Micro-computed Tomography: An In Vitro Investigation.

Background White spot lesions (WSLs) are common early indicators of enamel demineralization, particularly in pediatric orthodontic patients. Effective remineralization of these lesions is crucial for preventing further dental decay. This study aimed to evaluate the three-dimensional remineralization efficacy of two commercial toothpastes, calcium sucrose phosphate (CaSP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), using micro-computed tomography (micro-CT). Objectives To compare the remineralization efficacy of CaSP and CPP-ACP on artificially created WSLs in human premolar enamel using micro-CT assessment. Materials and methods Freshly extracted, caries-free human premolars were used for the purpose of the study. Teeth with any defects, including caries, non-carious lesions, fractures, or hypocalcifications, were excluded. Teeth were stored in a saline solution with 0.1% thymol at +4°C until experimentation. Enamel slabs (N = 18) of 3 x 3 x 1.5 mm were prepared from the buccal surfaces of the premolars and polished to a mirror-like finish. The slabs were divided into three groups (n=6 each): control, CaSP, and CPP-ACP. Specimens were demineralized in a demineralization solution for 72 hours and then treated with the respective toothpastes or remineralizing solutions for 13 days. Micro-CT scanning was performed to assess changes in enamel volume and mineral density. Statistical analysis included Shapiro-Wilk tests, paired t-tests, and one-way ANOVA with post-hoc Tukey's HSD tests. Results Enamel volume changes were significant between groups (p<0.01), with the CaSP group showing the largest remineralization effect. Enamel mineral density changes were also significant (p=0.004), with the CPP-ACP group showing the greatest improvement in mineral density.  Conclusions CaSP and CPP-ACP are both effective in remineralizing artificial enamel lesions. While CaSP shows comparable efficacy to CPP-ACP, further research is needed to confirm these findings in clinical settings. CaSP paste can be considered a viable, cost-effective alternative for enamel remineralization.

Blood pressure, brain lesions and cognitive decline in patients with atrial fibrillation.

Background: The influence of atrial fibrillation (AF) and blood pressure (BP) on brain lesions and cognitive function is unclear. We aimed to investigate the association of BP with different types of brain lesions and cognitive decline in patients with AF. Methods: Overall, 1,213 AF patients underwent standardized brain magnetic resonance imaging at baseline and after 2 years, as well as yearly neurocognitive testing. BP was measured at baseline and categorized according to guidelines. New lesions were defined as new or enlarged brain lesions after 2 years. We defined cognitive decline using three different neurocognitive tests. Logistic and Cox regression analyses were performed to examine the associations of BP with new brain lesions and cognitive decline. Results: The mean age was 71 ± 8.4 years, 74% were male and mean BP was 135 ± 18/79 ± 12 mmHg. New ischemic lesions and white matter lesions were found in 5.4% and 18.4%, respectively. After multivariable adjustment, BP was not associated with the presence of new brain lesions after 2 years. There was no association between BP and cognitive decline over a median follow-up of 6 years when using the Montreal Cognitive Assessment or Digit Symbol Substitution Test. However, BP categories were inversely associated with cognitive decline using the Semantic Fluency Test, with the strongest association in patients with hypertension grade 1 [Hazard Ratio (95% Confidence Interval) 0.57(0.42 to 0.77)], compared to patients with optimal BP (p for linear trend: 0.025). Conclusions: In a large cohort of AF patients, there was no association between BP and incidence of brain lesions after 2 years. Also, there was no consistent association between BP and cognitive decline over a follow-up of 6 years. Clinical Trial Registration: https://clinicaltrials.gov/study/NCT02105844, Identifier (NCT02105844).

Treatment of Patients With De Novo Small-Vessel Coronary Lesions: Analysis of Six Randomised Controlled Trials Comparing Paclitaxel-Coated Balloons With Drug-Eluting Stents.

Both paclitaxel-coated balloons (PCB) and drug-eluting stents (DES) are indicated for the treatment of de novo small-vessel coronary lesions. Since the evidence comparing these two types of devices is limited, we undertook a meta-analysis on this issue. Our meta-analysis compared the efficacy of PCB vs. DES in the treatment of patients with de novo coronary lesions of size ≤ 2.75 mm. Only randomized controlled trials (RCTs) were included. The two treatments under comparison were PCB vs DES; the endpoint was the rate of major adverse cardiovascular events (MACE). Our statistical methods were based on the reconstruction of individual patient data from Kaplan-Meier curves using the IPDfromKM algorithm. After this reconstruction, our statistical calculations included hazard ratio (HR) estimation with a 95% confidence interval (CI), assessment of between-trial heterogeneity, and risk of bias for each RCT. Our literature search identified six RCTs that met our inclusion criteria (PICCOLETO, BELLO, RESTORE SVD, BASKET-SMALL2, PICCOLETO-II, and DISSOLVE). In our main analysis, the six treatment groups using PCB were compared with the six control groups using DES. The results showed an HR of 1.029 (95%CI, 0.7446 to 1.422; P=0.86) over a follow-up of 36 months. Heterogeneity analysis across the six control groups showed worse outcomes in the BELLO trial and better outcomes in the three trials employing a limus-eluting stent. To evaluate trial heterogeneity through the comparison of the six PCB arms, five trials showed similar outcomes while the BELLO trial fared significantly worse. Risk of bias for each RCT was appropriate.  Our results indicate that in de novo small-vessel coronary lesions, PCB and DES showed similar outcomes, despite some cross-study variability. Our results provided meta-analytic confirmation that no recommendations can be made in favor of PCB or DES in the treatment of de novo small-vessel coronary lesions based on current data.

"Mimics" of Injuries from Child Abuse: Case Series and Review of the Literature.

The phenomenon of child abuse/maltreatment is underestimated and often represents a difficult challenge for healthcare professionals and forensic pathologists who must proceed with the differential diagnosis with accidental or self-induced events, or with lesions due to pathologies that overlap with that of mistreatment, defined as "Mimics". This study presents a case series with the aim of discussing lesions that may mimic signs of physical abuse in children but are due to a different etiology to raise awareness and train healthcare professionals and forensic pathologists on possible confounding factors in order to avoid diagnostic errors. Six cases of "Mimics" out of 418 cases of suspected mistreatment (1.43% of cases) were identified, presenting skin lesions initially classified as injuries of abuse due to their location and type and, in particular, sexual abuse for three cases. Then, the lesions and the subjects, in particular the anamnestic history, were examined by a multidisciplinary team and the diagnosis of genital lichen sclerosus et atrophicus in three cases, and the results of popular healing techniques (i.e., "cupping") in the other three cases were ascertained. These situations require specific skills and a forensic background from healthcare professionals to conduct a correct differential diagnosis and the intervention of a multidisciplinary team to investigate every possible pathology or alternative therapeutic practice that could simulate child abuse. In particular, when "mimics" are due to alternative medicine, it should not strictly be considered child abuse, but professionals must be aware of the hypothesis of mistreatment in case of non-medical indication or potential personal injuries from other crimes, such as illegal practice of the medicine. This awareness is also crucial to direct the child toward appropriate medical care, and it is essential to recognize that these conditions can coexist within the same clinical presentation.

Aminopeptidasic Enzymes as Early Biomarkers of Cardiac Surgery-Associated Acute Kidney Injury and Long-Term Events.

BACKGROUND: Diagnosis of acute kidney injury (AKI) relies on serum creatinine (SCr) changes. This study investigated if urinary aminopeptidases are early and predictive biomarkers of cardiac surgery-associated AKI (CSA-AKI). METHODS: Glutamyl aminopeptidase (GluAp), alanyl aminopeptidase (AlaAp), dipeptidyl peptidase-4 (DPP4), proteinuria, albuminuria, N-acetyl-ß-D-glucosaminidase (NAG), and neutrophile gelatinase-associated lipocalin (NGAL) were measured in urine samples from 44 patients at arrival in the intensive care unit (ICU) after cardiac surgery. Sensitivity, specificity, and positive and negative predictive value for diagnosis of stages 1, 2, and 3 of AKI were analyzed for the highest quartile of each marker. We also studied the relationship with SCr after surgery, 6- and 12-month glomerular filtration rates (GFRs), and other long-term events over the next 5 years. RESULTS: GluAp diagnosed the maximal number of patients that developed stage 2 or 3 of AKI, increasing diagnostic sensitivity from 0% to 75%. In addition, GluAp and DPP4 were related to the decrease in GFR at 6 or 12 months after surgery. CONCLUSIONS: Urinary aminopeptidases are a potential tool for the early diagnosis of CSA-AKI, with GluAp being the most effective marker for diagnosing stage 2 or 3 of AKI at ICU admission. GluAp and DPP4 serve as predictive biomarkers for a decrease in GFR.

Conjunctival Melanoma: A Clinical Review and Update.

Conjunctival melanoma (Co-M) is an aggressive, invasive eye and eyelid cancer. Its global incidence of ~1 in a million is increasing at a rate ratio of ~1.4, but this rises sharply in over 65-year-olds. Although rare, Co-M has a devastating impact on the lives of those who develop it. Co-M is often misdiagnosed or overlooked, leading to vision loss either from the destructive effects of the tumour or side effects of therapy, facial disfigurement from radical surgery, and death from metastases. Due to its rarity, there is limited evidence for diagnosis and management; hence, there is no standardised treatment and not all cases are referred to a specialised ocular oncology centre. Recent progress in cancer immunology and genetics have revolutionised the treatment of cutaneous melanomas, which share some similarities to Co-M. Importantly, a better understanding of Co-M and its precursor lesions is urgently needed to lead to the development of novel targeted and immunotherapies both for local tumour control and disseminated disease. This review aims to provide a comprehensive clinical overview of the current knowledge regarding Co-M, its epidemiology, pathogenesis, presentation, diagnosis and recent changes in the classification of its precursor lesions, management, and recent advances in novel biological therapies for personalised treatment of this disease.

Voxel-Based Lesion Analysis of Ideomotor Apraxia.

Ideomotor apraxia is a cognitive disorder most often resulting from acquired brain lesions (i.e., strokes or tumors). Neuroimaging and lesion studies have implicated several brain regions in praxis and apraxia, but most studies have described (sub)acute patients. This study aimed to extend previous research by analyzing data from 115 left hemisphere chronic stroke patients using the praxis subtest of the Western Aphasia Battery, which is divided into four action types: facial, upper limb, complex, and instrumental. Lesion-symptom mapping was used to identify brain regions most critically associated with difficulties in each of the four subtests. Complex and instrumental action deficits were associated with left precentral, postcentral, and superior parietal gyri (Brodmann areas 2, 3, 4, 5, and 6), while the facial and upper limb action deficits maps were restricted to left inferior, middle, and medial temporal gyri (Brodmann areas 20, 21, 22, and 48). We discuss ideas about neuroplasticity and cortical reorganization in chronic stroke and how different methodologies can reveal different aspects of lesion and recovery networks in apraxia.

Coronary Arteries Lesions in Kawasaki Disease: Risk Factors in an Italian Cohort.

Background: Kawasaki disease (KD) is a systemic vasculitis of medium arteries, particularly involving coronary arteries. Coronary artery lesions (CALs) is the most serious complication in the acute stage, potentially leading to ischemic cardiomyopathy, myocardial infarction and sudden death. Environmental factors and genetic background contribute to individual susceptibility to develop CALs. The aim of this study was to define the risk factors for CALs in an Italian cohort. Methods: Data of KD patients from 10 Italian sites were registered into a REDCap database where demographic and clinical data, laboratory findings and coronary status were recorded. KD was diagnosed according to AHA definition. We used multiple logistic regression analysis to identify independent risk factors for CALs. Results: A total of 517 patients were enrolled, mainly Caucasians (83.6%). Presentation was complete in 321 patients (62.8%) and IVIG responsiveness in 360 (70%). CALs developed in 136/517 (26.31%). Gender, age, ethnicity, clinical presentation, fever duration, non-coronary cardiac events, Hb, albumin and CRP were significantly different between patients with and without CALs, while seasonality was not. Male gender, age < 18 months, Asian ethnicity, incomplete presentation and fever > 10 days were independent risk factors for CALs. Conclusions: Age younger than 18 months, incomplete KD and longer fever duration are risk factors for CALs. Asian ethnicity also represents a risk factor in our Italian Cohort.

The Relationship between Lipoprotein A and the Prevalence of Multivessel Coronary Artery Disease in Young Patients with Acute Myocardial Infarction: An Observational Study.

Introduction: Cardiovascular diseases are the leading cause of mortality worldwide, with a significant impact on socioeconomic aspects. Various biomarkers have been studied in relation to the diagnosis, progression, and prognosis of atherosclerotic disease, with lipoprotein (a) [Lp (a)] standing out as an important predictor of cardiovascular risk. This observational study aimed to clarify the association between Lp (a) levels and the severity of significant multivessel coronary lesions in acute myocardial infarction (AMI) patients. Materials and Methods: Conducted at the Clinical Emergency County Hospital of Craiova, Romania, the study involved 256 young patients divided into two groups based on Lp (a) levels: Group A (Lp (a) < 30 mg/dL) and Group B (Lp (a) ≥ 30 mg/dL). Patients included young adults up to 55 years for males and 60 years for females, excluding those with familial hypercholesterolemia. Results: The study revealed a significant association between elevated Lp (a) levels and the presence of multivessel coronary lesions. Patients with Lp (a) concentrations ≥ 30 mg/dL exhibited a higher prevalence of multivessel disease compared to those with lower levels. Discussion: The findings suggest that elevated Lp (a) levels are a crucial biomarker for the risk of coronary artery disease, particularly in young patients with AMI. The study emphasizes the need for aggressive lipid management strategies and personalized treatment approaches, considering the significant role of Lp (a) in atherosclerosis and AMI. Conclusions: Lipoprotein A levels above 30 mg/dL are associated with a higher prevalence of multivessel coronary lesions. Multivariate analysis revealed that higher Lp (a) levels and lower HDL levels are linked to an increased risk of multivessel coronary lesions.